September 19, 2011

Behind the Mask

This was a good week for me as it relates to reading -- I finished two books!

Behind the Mask: the Mystique of Surgery and the Surgeons who Perform Them was written by a general surgeon and fellow blogger (Heard in the OR). It was a wonderful peak inside of a world that I've been fortunate enough to see firsthand. However, Dr. Gelber uses this book to educate us lay people on the body and common surgical procedures. He also shares stories and his perspective on a variety of issues. It helped me fill in some of the missing pieces in my operating room (OR) knowledge generated from years of talking to surgeons and those peaks into the OR during my rounds.

This book should be required reading for anyone in medical school, hospital administrators (especially those who work directly with surgeons) and anyone involved with setting policy related to reimbursement and payment for surgical procedures. I also recommend it for the reading list of my fellow Baby Boomers who may one day soon be referred to a General Surgeon.

A few things from the book stand out for me and I share them below.

"Training, experience, insight, knowledge, and more than a touch of humility combine to create a surgeon."

"The truly great surgeon is never so arrogant as to believe that something can't be wrong."

"The human body is constructed in a remarkable way that keeps it running during the most trying situations."

I learned about the omentum - "...an organ that brings new blood supply to areas in need" and its important role as a "watchdog".

Dr. Gelber discusses the importance of talking with the patient to help the physician head in the right direction.

He reviews the role of surgery pre and post diagnosis of Sepsis and need for immediate and aggressive response. As he states, "... more malpractice lawsuits are won due to inadequate treatment of a complication than for the actual complication."

He comments on the risk of not allowing nurses (especially those in critical care) to "think" and it highlights the need to update nursing licensure and scope of practice requirements, especially given the anticipated shortage of physicians and nursing professionals.

He brings up the important issue of end-of-life and palliative procedures.

And,he shares his frustration with knotted patient gowns. I wonder if he (and administrators) know gowns with snaps exist and they are ideal for surgical patients and helping the surgeon access the right area of the body without frustration? (I learned about these after the linen staff notified me of the high rate of riped gowns.)

Over the years, I've worked with some wonderful surgeons. Some had a rough edge and others had a bit of an ego, but all were truly caring and dedicated professionals. This book has given me some new insight and knowledge to have more intelligent clinical conversations with surgeons and ensure that clinicians have what they need to care for our patients - today and in the future.

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Thank you so much for taking the time to read my book and for your kind words. "Behind the Mask" was written to bring the reader inside the world of surgery and into the mind of a surgeon. Find out more at my blog http://heardinthor.blogspot.com

As an ICU director, I have always had an excellent rapport with my surgical colleagues. Building trust over the years has been extremely important as I served as those second set of eyes to watch for signs of post operative sepsis. I have seen many surgeons go from "it can't be from my surgery" to "we need to aggressively decide if it is a surgical infection and then I must go in". One of the most rewarding parts of being an intensivist is to be able to partner with my surgical colleagues and to be able to call them in the middle of the night to share my suspicions and for them to jump on it and save a patient's life one more time.